0_lembar Follow Up Bangsal.doc
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FAKULTAS KEDOKTERAN UNIVERSITAS PALANGKA RAYA Nama : PERJALANAN PENYAKIT INSTRUKSI DOKTER Ruangan : ( Diisi Oleh Assisten Ahli ) Perjalanan Penyakit Tanggal / Jam ( Ditulis Pend. Tindakan yang Diambil a.l. Bila Operasi )
Tanggal : Pukul
:
TD :
mmHg
DN :
x/m
RR :
x/m
T :
0
C
Umur : Nomor : INSTRUKSI DOKTER
Tanda Tangan ( Nama Jelas)
Tanggal : Pukul
:
TD :
mmHg
DN :
x/m
RR :
x/m
T :
0
C
Umur : Nomor : INSTRUKSI DOKTER
Tanda Tangan ( Nama Jelas)
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